Scots debate on end-of-life care - L'Infirmière Magazine n° 275 du 15/03/2011 | Espace Infirmier

L'infirmière Magazine n° 275 du 15/03/2011



End-of-Life (EoL) care issues and the ethical questions they raise are making the headlines around the globe. In Scotland, on 5 December 2010, the Palliative Care Bill(1) was withdrawn from Parliament. MSP Paterson, who introduced the bill, hoped to eliminate variations in EoL care due to postcode lottery and type of illness.

At the same time, MSPs rejected Macdonald’s End-of-Life Assistance Bill(1) which would have given patients the right to choose when to die. Physician-assisted suicide is the practice of providing a competent patient with a prescription for medication for patient use with the primary intention of ending his or her own life.

Opponents of the Macdonald’s Bill(2) expressed concern that the introduction of physician-assisted suicide could slow down funding and research in the area of P. C.

« Society needs to know that you can’t have both physician-assisted suicide and palliative care. In reality, you can only have one or the other, » an MSP said.(3)

In a report on the P. C. Bill, it was considered that « establishing a definition of palliative care in statute which is simple and unambiguous is challenging… »(4)

A NHS Board manager argued that legislation would help to break down barriers between local government and healthcare professionals. « Some of the barriers have been down to confusion about roles and who sets the agenda. Why is a manager setting an agenda for a clinician ? Such tensions always exist in the constructs that we have created for service delivery. »(4),(5)


2- Video available at :

3- MSP MacMahon, article at


5- En Écosse, 14 « boards » (comités) du National Health Service (NHS) s’occupent des services de santé pour des régions, calqués, en gros, sur la carte politique. Chaque board comprend des managers non soignants, des « health managers », intégrant des représentants de l’administration (politique) locale.


MSP (n)

Member of the Scottish Parliament, député au Parlement écossais

Physician (n) médecin

Competent (adj)

Ici, capable d’assumer ses décisions

Local government (n)

Administration locale (voir le rôle des politiques dans les comités de santé, note 5)

Clinician (n)

Professionnel de santé, médecin, infirmière ou autre.


1. Is palliative care currently available in Scotland ?

Yes, but not everywhere and not to patients with all life-limiting conditions.

2. Do opponents of the Macdonald’s Bill believe that P. C. is compatible with physician-assisited suicide ?

No, they believe it is an ethical and a financial choice ; agreeing to PAS would result in less funding for P. C.

3. Why is a manager setting an agenda for a clinician ?

Because within the NHS Scotland system, non­healthcare managers are instructing healthcare professionnels on how to implement government health policy.

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